diabetes insipidus (agu presentation)

7/28/2019 Diabetes Insipidus (Agu Presentation)

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DIABETES INSIPIDUS

DR. JALILA AL AALI

CONSULTANT ENDOCRINOLOGIST

SALMANIYA MEDICAL COMPLEX

February 28th 2006



CASE HISTORY

■ 33 year old female patient, presented with

history of passing large amount of urine

( about 7 liters / day), for two weeks.

Urine osmolality 110 mOsmol/ L

Serum osmolality 289 mOsmol/ L

Serum Na+ 149mmol/ L



WATER DEPRIVATION TEST

TIME S.osmo S.Na+

U.osmo U.Na+

Basal 289 141 35

2H 296 146 70 19

4H 297 147 105 256H 289 147 105 25

8H 304 150 175 33

POST VASOPRESSIN1H 293 142 - -

4H - - 140 25




Interpretation:■ Low urine osmolality at baseline.

■ After 8 hours, serum osmolality increased,

but urine osmolality remain low. Diabetes Insipidus

Vasopressin No change in urine omolality

Nephrogenic Diabetes Insipidus



CASE HISTORY

■ 40 year old Indian male, who complained

of headache for 3 months.

■ Investigations revealed suprasellar

craniopharyngioma.

■ Excision done by craniotomy.



CASE HISTORY (cont.)

■ One day postoperatively, he started to pass

large amount of urine ( 6 liters / day ).

Urine osmolality 45 mOsmol/ L

Serum osmolality 295 mOsmol/ L

Serum Na+ 149mmol/ L




TIME S.osmo S.Na+

U.osmo

Basal 295 149 45

2H 296 149 70

4H 297 150 95 6H 299 152 101

8H 309 153 125

POST VASOPRESSIN1H 293 142 435

4H 287 141 729




Interpretation:■ Low urine osmolality at baseline.

■ After 8 hours, serum osmolality increased,but urine osmolality remain low.

Diabetes Insipidus

Vasopressin

Increase in urine omolality

Central Diabetes Insipidus



DIABETES INSIPIDUS

Definition:

Defined as passage of large

volumes (more than 3 litre/24 hrs)

of dilute urine (osmolality less than

300 mOsmol/kg).



Classification:

① Cranial: due to deficiency of circulating

ADH.

Causes: Trauma

Tumors

Idiopathic

Inflammatory conditions

Infections

Familial (AD)



② Nephrogenic : due to renal resistance to

ADH.

Causes : Familial (X-linked recessive).

Drugs (lithium, demeclocycline).Metabolic (hypercalcemia,

hypokalemia).



③ Primary polydipsia:

Psychological excessive water drinking

Suppression of ADH

Polyuria

Increase excretion of solutes

Reduce urine concentrating capacity



DIAGNOSIS

► Large amount of diluted urine ( more than3 liters/day, and osmolality less than 300mOsmol/kg).

► Hypernatremia ( Na+ ).

► Increase serum osmolality ( more than 295mOsmol/kg ).



Water deprivation test

No change in urine volume & osmolality

Diabetes Insipidus Give 2 µg IM desmopressin

DIAGNOSIS

Urine osmolality No change inUrine osmolality

Central D.I Nephrogenic D.I



Treatment

► Central : Vasopressin analogue ( Desmopressin )

intranasally or parentrally ( SC, IV, IM).

► Nephrogenic:

Thiazide diuretics.

diabetes insipidus (agu presentation)

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